My husband and I recently opened up a medical spa and we are looking to add lasers...preferably one that does hair removal/skin resurfacing/age spots that sort of thing. I would like recommendations and why you recommend it. Thanks in advance.

I hope one of you is physician. Best of luck to you , honestly. The number on business these days is medspa liquidation ! If you know your science --- i recommend going with used laser equiptment.

KeelyTx:
What kind of population are you serving? gender, age range, ethnic types (fitz I thru VI), your surrounding competitions???? There is no true all-purpose laser platform. Any sale rep telling you that should be shot. Make your determination FIRST based on your pracice profile, then decide on specific platforms, THEN call the company just to place the order. Don't let the sale rep manipulate you. Sorry for sounding somewhat ambiguous to your inquiry but it is imperative that you objectively identify your market first before making decision on laser machines. This will minimize risks of side effects or poor clinical outcomes or buying the wrong laser platform for your targeted client base. If you can give me more such detailed info, maybe I can help.

KeelyTX,

Please, please do your research before making such a large investment. I purchased a Sciton 1064 nd:yag for hair and veins that I was very happy with but due to a sudden life change need to sell. The sales reps will all tell you that their laser is the most desirable for resale and not to worry, but I have learned differently. pmdoc is offering you some great advice, I hope you take it. If you are interested in used, let me know! Best of luck to you and your husband.

We are looking at selling our Cutera IPL and Hair removal lasers. If you are interested, please call 817-938-4414. We are in Dallas, TX. They are 1.5 years old and still under warrenty.

pmdoc

You seemed quite informed on laser therapy.
What type of lasers are you using and which do you like best for wrinkles are you using a fraxtionated laser.

DH:
Sorry for this late reply. I have not been on this lately and missed your post from a week ago.I have used the following products (GentleLase 755nm, Gentle YAG 1064, VBeam, VBeam Perfecta 595nm, MedLite Q-Switched 532 and 1064, Lumines Quatum SR 560,590 and 640nm, Palomar Starlux, Aesthera PPX, Portrait Rhytec, Fraxel Re:Store 1500 and Thermage). In regards to wrinkles, depending on where on the face. In general, for fine wrinkle (crow's feet) you can go with pulse dye laser 595nm or IPL or Fraxel. For moderate to deeper ones, this is more difficult. You can go with Portrait Rhytec, CO2 or Thermage or Alma Accent. With Thermage or Accent, you get the added "lifting" effect which work better on the sagging wrinkles/skin as in the jowls or the droopy upper eyelids though a strong full ablative CO2 as in Luminis Active FX can do such for the eyelids. Sometimes, wrinkles can also be corrected with fillers such as radiesse, perlane or restylane as those on forehead or glabellar. Wrinkles can also result from tissue atrophy in the mid and lower face. In these instances, an AUGMENTATIVE volumizing injection (with Perlane or Radiesse) will stretch out the loose skin thus not only fading out the wrinkles and folds but also giving the lifting effects

pmdoc,

Thank-you for your response. What do you know about Almas SHR or their Pixel. What do you feel is best for facial resurfacing? Every rep tells you thier product is best. What do you know about the Scyton Profactional and Microlaser?

DH:
What the Alma "SHR"??? Hair removal??? If it is for the hair removal, it is not very good b/c it is a diode laser since 755nm is best for Fitz I-III and 1064 Nd-YAG best for III-VI. Many companies would resort to 810 diode to stake them that it can treat all skin type since it is in between the 2 spectrums. However, this does not work out well at all. Besides, their diode has a pulse width down to only 30ms which is not adequate for good hair removal since you need PW down to 10-20ms. Their Pixel is Erbium device but not very good one b/c it uses the stamping technique, not an "advanced" concept. Sciton Profactional is also erbium platform. I don't know much of it in details but it seems to be probably the best erbium platform around. What is the best skin resurfacing platform????? The gold standard has always been CO2 laser but this WAS limited by long downtime, high adverse risks (especially post-inflammatory hyperpigmentation) and not indicated in Fitz III-VI for full ablation especially. The best CO2 platform today that I can recommend on is Luminis Active FX. However if your client profile is mostly type III or higher then the safest one would be Fraxel 1500, Palomar 1540, Lutronic MOSAIC, CoolTouch 3TC 1320nm. Otherwise, you can go for the new Fraxel Fractional CO2, probably better in results but still with slight risks in darker skin people. I hope this helps. By the way, are you new to the field?? What is your clientele profile??? In general, it is most worth the investment to focus on skin resurfacing, tightening and body shaping. There is not much money and satisfaction in LHR (Laser Hair Removal) If you have not done LHR, DON'T. Good Luck

Anyone looking to purchase a Palomar, look into their new corporate policy about re-selling used. They are charging $30,000 and calling it a transfer ownership fee plus you have to buy a new warranty approx. $6000. How they can get away with this is beyond comprehension. This makes your new $120,000 starlux worth less than half the minute you buy it. This is a bad company, good equipment.

So what modality is the best for hair removal -- the diode -- the NdYag -- or IPL????
I would like to purchase one system only. Has anyone used the clear scan by Sciton?

I have a Cynosure Apogee Elite 2007 which is an Alexandrite and an ND:Yag which accomodates all Fitzpatrick skin types for hair removal, plus veins and age spots. It works beautifully and is in mint condition. Am considering leaving the business and can transfer the lease if you are interested. Have not used the clear scan by Sciton.

Is the warranty also tranferable?
What is the monthly payment?
Where are you located?

Does anyone know where to rent a Sciton Profractional?
I also have a Palomar Starlux with G, Rs, Y, and V handpieces for sale. Send inquiries to terryb@wittenbergnet.net

pmdoc:
what is your experience/results with Aesthera's PPx/Isolaz? I have gotten very good response treating acne, fair with hair and mixed results with photo-rejuv.

laser94025:
I don't use much of Aesthera since the problem with it is you cannot manually adjust the pulse width or fluency. It goes by the "treatment level which I have no way of extrapolating. That is why you get only fair results with hair since you need to be able to "dial down" pulse duration in order to go after the hair bulb. I believe it works fine on pigmentation. Where in CA are you?

Did someone have experience with palomar Deep IR fractional for skintightening of face? Can you compere it with Titan or Thermage

You have a lot of experiences with lasers. What do you think about Palomar Star lux 500 deep IR fractional for skintightening of face, does it really work?

doc33:
IR is IR is IR. It does not go deeper than 1-2cm. As far as I know no IR platform is FDA-approved for skin tightening. You might get some results in thin skin people or thin skin area such as the neck, but impossible in the jowls, NLF nor Marrionette's lines. Thermage is monopolar RF. SOme of the newer tips now can get down to 4.3cm to do body contouring and cellulite treatment. Check thermage website for before and after pics. Then see if any IR companies can show you pics that are even close to those.

Thank you Pmdoc, I am awere that the Termage has better results, but the tips are too expensive, and the pain is high.My conserns are is the Titan better device then Palomar deep IR fractional if you compere the results and the pain. Palomar is much more practical to use in my opinion, and the head has 50.000 imp and Cuteras only 10.000.
You say that it can be some improvment in thih skin such as neck, how about the crow feet in temporal region, or forehead in womem with thin skin.Jow is more difficult, does it help if you use higher energy or more treatments.Do you have personal experience with Palomar deep IR.

doc33:
If I may make a correction: IR does only to 2mm, thermage STC tip goes to 2.5CM. I had the pleasure to get into the Cutera site today to read up quite carefully on several clinical papers written by their dermatologists (drs Taub,Fincher, Battle,Zelickson, Ross,Counter, Spooner,Nikolaidis) who received discounts for using its Titan product to start with. The concensus of the IDEAL patient for Titan is (MultiCenter Clinical Perpectives on a Broadband IR light device for Skin Tightening): "..(someone with) early change along the jaw line and thin submental skin with no fat to support. Patients with a large amount of redundant skin can also benefit, but resutls are more difficult to achieve when subcutaneous tissue is voluminous, possibly b/c infrared light penetrates ONLY 1-2 mm in depth.." To put this in a more practical picture: someone of Fitz I-II, in the 30's and skinny with expectation mostly limited to the neck area. By the way, the clinical endpoint even for IR is: "...(to titrate upward to make the pt feel) warm to hot sensation...but are not so uncomfortable that they want to withdraw from the pulses). My bottom lines to you are:
1) There is NO such thing as a painless skin tightening platform. The indisputable FACT is: you need to heat up the dermal layer to at least 58C for collagen denaturation to occur
2) It takes 1.5 mm to get past the epidermis to the first dermal layer called papillary dermis.
3) Because of the HUGE difference in depth of penetration (1-2mm vs 2.5CM) that only thermage can get you the so-called volumetric BULK tissue heating thus bulk tissue lifting effect
4) With the thermage platform, you can also now do body shaping (DC tips with 4.3CM depth) and cellulite (CL tips with 4.3CM depth)
5) I understand that it costs close to $1 per Titan pulse. For a 600 pulse 3.0cm2 thermage tip which is sufficient for a full face and neck, it costs about $550 for ONE time deal)
I hope this helps

pmdoc,------ the bottom line is clinical results both suck.
come on now... honestly, i have both titan and thermage (recently sold to third party) . i do not think thermage is drastically better than titan. i really have not seen that great of result in either. I agree w/ Dr. Esparza at UCSD. --- THERE IS NO REAL CLINICAL DIFFERENCE IN EITHER TITAN OR THERMAGE. THERE IS NO CLINICAL DATA OR EVIDENCE BASED THAT SUPPORTS EITHER IS CLINICALLY FAR SUPERIOR THAN THE OTHER. .....Only that I had one case of fat tissue necrosis. 0therwise, all these nonablative devices are basically the same crap repackaged, with minimal improvement. see real self.com patients would agree across the country titan or thermage. the only way to sink heat in would be resurfacing fractional or otherwise.
PS the titan is NOT $1.00/shot it is exactly .30 cents. 10,000 shots for 3000.00 refill; you need about 250-300 shots for a full face so thats 75.00 + doctors time + etc....

you can add lux IR or synerons refirme its all the same , same type of result: minimal.. I would go with Palomar or Syneron with NO refill or disposables. both titan and thermage is not worth the money or time.

Eimal:
First of all, I don't know who the hell you are. By your unprofessional tone, I doubt you are a physician. Also, why would I care to find answers from a website such as realself.com anyway?? You sound like a moron. Let me ask you this: What is your professional authority is this arena anyway?? How many Thermage have you personally perform to even make any such statement?? It is not unreasonable to lump all IR's into one such those of Syneron, Alma, Palomar and Titan. So your point is nothing to get excited about.

do whatever.....you are the greatest you are so smart. pmdoc.

Eimal,

I own both Thermage and Titan and I feel that the results are better with Thermage than with the Titan. I rarely use my Titan any longer. Were you doing the newer protocols? I have always done the newer protocols but have a friend that only did the old protocol and he did the same thing as you and sold his. He was not impressed with it. I have had multiple patients that had the old protocol and then I did the newer protocol and they felt they had better results the second time. One thing to think about though is that at least Thermage continues to try and improve their system by changing the tips. Trying to improve protocols etc. Cutera has only made the tip larger or more easily visualized. They have done nothing to improve their protocols. I actually own the SkinTyte by Sciton. It came with my system so I use it over the Titan as they are similar technology and the Sciton costs me nothing to use. Palomar does have consumables just like Titan as you have to replace the head.

pmdoc,

eimal is correct on the cost of the Titan cost per pulse it is 30 to 33 cents per pulse depending on the head you purchase. We usually did 300 to 400 pulses for a full face using the Titan which would come out to about $120 per treatment plan 3 to 5 treatment $360-600 plus 3 to 5 hours of my time. Thermage 900 pulse stc tip about $750 plus 1 hour of my time. You can now get the 900 pulse stc tip for $440 through Thermages new partner program (just notified about this today).

The biggest thing everyone needs to learn about these technologies is do not overpromise. I hate seeing Thermage advertised as "the lunchtime facelift". It gives us a bad name.

LH:
I was only saying that as I "understand (as I was told by a Titan owner) that it costs close to $1 a pulse" I did not say I knew this as fact. By the way, I use 600 pulse 3.0cm2 for FF and neck.

LH:
I was just trying to be of help to doc33. I tried to be as objective and factual as I could. Don't you just hate it when someone from nowhere just blindsided you, jumping out at you like this by making "subjective and abstract statements" If she was going quote from Dr.Esparza she needed to give me the article source so I could read up on. I have seen great Thermage photo results from him. It is true that Thermage is trying to stay competitive by offering innovations. Honestly at this time their only major competition is the Alma Accent since it is of similar platform thus capable of bulk tissue effects. By the way, the cellulite tips came out this week. I also plan to come to their users meeting in SF on April 19th.

pmdoc,

I wish I could make SF but will likely go to Chicago the 29th. Aren't they taking Alma to court for patent infringement? As of right now Thermage is still the gold standard. I know it is not perfect and I tell my patients. Everyone of my patients knows that it is variable. I have done about 50 cases so far and not one has asked for their money back but I have had that occur with the Titan.

LH:
Yes, Thermage and Alma are in court right now for patent infringement. It is funny that Alma took the pre-emptive strike suing Thermage as soon as its Accent was introduced to the market last June, 2007.The key with Thermage is to do one half face at a time to show its effects on a split-face. Also, for people older than 60-65, I would push for the combo with fillers and botox to enhance the results.

One more thing also, since 2006 I have never had anyone coming back after thermage with complaints. That is probably after close to 2000 cases by now

Thank you all, especially pm doc
I have more clear picture about the skin tightening treatments.
All of you have experience with Termage and Titan ( good or bad ) Does anyone have personal experience with Palomar Star lux.500 deep IR. They said their IR 850 - 1350 nm goes 2-3 mm into skin, they work with much higher energy up to 154 J/cm than Titan.

For what its worth, we determine what skin tightening device to use on the patient by the thickness of their skin and of course if they have any metal or titanium in them. We have done ReFirme above the knees but stick with Thermage mainly on the body- abs,etc. For lower face and neck, we look at the skin thickness. You could ideally do Thermage, one month later, ReFirme, one month later Titan- you are hitting all three depths and then evaluate over six months.

pmdoc, you seem to be quite in the know, for a practice that is just now adding hair and vein removal to a practice already using filler which laser product would you choose, we already do sclerotherapy for veins

AS:
That IS a lot of English in your one sentence, LOL. Let me clarify your story. You already had sclerotherapy and fillers in your practice. At this time, you are considering something for hair removal and telangectasia (spider vein) treatments. If this is a correct assumption on my part then I need to ask you for your patients' ethnic profile. Are they mostly Fitz type I-III or III and higher??? On a balance, is it more of hair removal or spider vein removal that you wish to focus on??

PMDOC-where are you located? Do you have a personal email? I would like to speak with you off the blog about lasers. Your knowledge is very impressive, and our practice is embarking on a laser purchase. I've reviewed the ROI numbers. Would it be possible to have a conversation with you?

PMDOC,
I would also like to spend a few hours talking to you about what lasers to purchase, creams and consultations. Can we talk offline?

pmdoc,
Sorry to see this exchange end- I will soon be opening a predominantly a clininc in a predominantly fitzpatrick III-VI area and trying to do so on a responsable budget. As a newbie in this arena my passion at this point has been injectables. To compete in the market treating hair and veins seems like the obivous modality to extend into-(other opinions are welcome) I have been looking at the Cynasure Elite which has the Alex and 1064 for darker skin type. Any input or experience?? As a side note, no suprise, the Cynasure rep also pitched on the Affirm as an initial alternative investment- any opinion/experience with a darker skin types population which therapeutic modality, skin tightening/anti-aging or hair/veins, would have the greatest calling? Thanks

If you go the cynosure apogee elite route or the affirm, there is no reason to purchase it new. I am a serivce technician and the price differential is huge when comparing new and used. I know the company i work for sells them pre owned all the time. They also offer service contracts and offer all the accessories ( fibers, handpieces, etc ). www.spectrumlaserservices.com